| NPI | 1417630120 |
|---|---|
| Former Name | JENNIFER COSTELLO |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN2317192) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: MA RN2317192) |
| Enumeration Date | 2023-08-09 |
| Last Update Date | 2024-06-11 |